A 12-YEAR-OLD WHITE GIRL presented with a midline cervical lesion present since birth. A fibrous cord that limited extension of her neck was associated with the lesion. The patient noted occasional mucoid discharge from the inferior aspect of the lesion (Figure 1 and Figure 2). Her medical history was unremarkable, and she had never received any prior medical or surgical intervention for the lesion. On physical examination, a small skin tag was noted at the superior aspect at the level of the hyoid bone. An excoriated, dry tract extended inferiorly and terminated in a small fistulous tract with scant mucoid drainage. The lesion was not affected by swallowing or tongue protrusion.